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Accuracy of position of cutting and drilling guide for sagittal split guided surgery: a proof of concept study
Affiliation:1. Private Practice, 19, rue de Téhéran, 75008 Paris, France;2. Consultant, DRA Villa 747 Jumeirah Beach Road, Dubai, United Arab Emirates;1. Clinical Staff, Maxillofacial Oncology and Microvascular Reconstruction, Department of Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, QC, Canada;2. Director and Associate Professor, Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, McGill University; and Chief, Department of Dentistry and Oral and Maxillofacial Surgery, McGill University Health Centre, Montreal, QC, Canada;1. Department of Orthodontics, University Medical Center Goettingen, Goettingen, Germany;2. Department of Oral and Maxillofacial Surgery, University Medical Center Goettingen, Goettingen, Germany;1. Department of Diagnosis and Surgery, Division of Oral and Maxillofacial Surgery, São Paulo State University (UNESP), School of Dentistry, Araraquara, Brazil;2. Private Clinic, Santos, São Paulo State, Brazil;1. Aggregate Professor, Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Salerno, Salerno, Italy;2. Associate Professor and Chairman, Department of Oral-Maxillofacial Surgery and Pathology, University of Mississippi Medical Center, Jackson, MS;3. Private Practice, Department of Medicine and Surgery, University of Salerno, Salerno, Italy;4. PhD Student, Department of Industrial Engineering, University of Salerno, Salerno, Italy;1. State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China;2. Department of Orthodontics, Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, No. 639 Zhizaoju Road, Shanghai, PR China;3. State Key Laboratory of Oral Diseases & National Clinical Research Centre for Oral Diseases, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, 14 Ren Min Nan Road, Chengdu, 610041, PR China;1. Service de chirurgie maxillo-faciale et plastique de le face, CHU Clocheville, 37044 Tours, France;2. Service de neurochirurgie pédiatrique, CHU Clocheville, 37044 Tours, France;3. Centre de compétence craniosténoses et malformations craniofaciales rares, CHU Clocheville, 37044 Tours, France
Abstract:The benefits of three-dimensional planning and guided surgery have been realised over the last few years in maxillofacial surgery. Reproducing the exact positioning of the cutting and drilling guides on the flat mandibular angles defined by the engineer is a challenge for the surgeon and for the reliability of guided bilateral sagittal split osteotomy. Reference screws positioned on the skeleton before the acquisition of medical computed tomographic data can provide a fixed landmark that can be used during surgery and by the engineer during the design phase. The objective of this proof of concept in vitro study is to calculate the accuracy obtained for guides positioned by inserting a reference screw. The precision obtained for 30 guides following the insertion of 30 reference screws on 15 mandibular models was analysed. The models were scanned using an optical scanner and compared to CAD-CAM projects. The mean (SD) absolute position (in)-inaccuracy is 0.1616 (0.1141) mm for the entire guide surface and 0.13143 (0.0835) mm for the rim surface. The results indicate that the use of reference screws is efficient, and so they can be used to position guides accurately during guided bilateral sagittal split osteotomy.
Keywords:Reference Screw  Guided surgery  Orthognathic guided surgery  BSSO  Splint-less  Cutting guides  Drilling guides  Custom plates  CAD-CAM  3D Printing
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